HomeMy WebLinkAboutT12N R3W SEC 9 LT 71!'
Gr "rER ANCHORAGE AREA BOROI 't
DEr~R1'MENT OF ENVIRONMENTAL QUALI~,
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
ADD R~SS j_.~.-),--~e~
LEaAL DESCRIPT~ON
SEPTIC TANK:
NUMBER OF
DISIANCE FROM WELt (2~/~/11~)1/2" ____ MATERIAL._ ~-~- COMPARTMENTS
LtQUID
LIQUID CAPACITY .._ Jff'~'D GALLONS INSIDE LENGIH JNSIDE WIDIH ~ DEPIH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS_ // OUTSIDE DIAMETER
LINING MATFRIAI ~-;c
NEAREST LOT LINE E~L; /~ ~
-'- OR WIDTH / 2 , IENGTH~/~''~'_, DEPTH ~'>
DISTANCE FROM WELL ~-~OJ~. , BUILDING FOUNDATION '~' -~
[O~AL EFFECTIVE ABSORPIION AREA (WALL AREA) ~. dj SQ. FT.
TILE DRAIN PIELD:
DISTANCE FROM WELL__~ ~.~__--~:~)LINQA~.ON__ , NEAREST LOI LINE
NUMBER OF LINES / DISTANCE BETWEEN LINES ~_ - ~[RENCtl WiD]H
/ CH L~
ABSORPTION O~A SQ. FT. LENGIH OF EA ~
DEPTH: TOP OF 11LE TO FINISH GRADE.
TOJAL LENGTH
DEPTEI OF FILTER MATERIAL ISENEATEI TILE IN. ABOVE TILE
WELL: TYi) E (.'C21Vi iV}' DEPTH_ --
,~ NEAREST SEPTIC
LOT LINE , SEWER LINE_ , TANK
DISTANCE FROM -- WA~ER '-
BUILDING FOUNDATION. __ SAMPLE NEAREST
- OTHER
_- SEEPAGE ,.~
· SYSTEM____ , CESSPOOl , SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
GREAl ER ANCHORAGE AREA BORuUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3~00 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO,
LEGAL BESGRIPTION
INSTALLATION OF: SEPTIC TANK -
TYPE AND SIZE OF FACILITY TO DE SERVED
FINANCED THROUGH ~(
COMPLET[ON DATE ANTICIPATED
¢ / / - /
FINAL INSPECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BI,-" SUBJECT TO pROSEC, LITION.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEEPAGE PIT ~) [ ., DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /'~/- [
SEPTIC TANK
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK
DRAIN FIELD-----
, SEEPAGE PIT ,
'~ [ . DRAIN FIELD
· ALSO CONS[DER AREA WELLS.
/
WATER MAIN TO SEPTIC TANI( -- ~
DRAIN FIELD--
SEPTIC TANK, SEEPAGE PIT . DRAIN FIELD . ,
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO~[~{ G~/~L~f
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
DIAGRAM OF SYSTEM
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
GREATE RAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
I CERTIFY THAT I AM FAMILIA~ WI'tH THE REQUIREMENTS OF ~~/ / ~_~